Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BNF: Respiratory System > 1/6 Airways Disease, Obstructive > Flashcards

1/6 Airways Disease, Obstructive Flashcards

6 Parts of Chapter 3. This is the first part

1
Q

Define Asthma

A

Asthma is a chronic inflammatory condition of the airways, characterised by bronchoconstriction.

The most frequent symptons are: Cough - Wheezing - Chest tightness - Shortness of Breath. May require hospitalisation if it gets too bad

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Outline the Aims of Treatment in Asthma

A

No daytime symptoms, no night time awakening due to asthma, no asthma attacks Peak Flow/ FEV1 Greater than 80% as in the normal lung.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Outline the lifestyle changes in Asthma

A
  • Weight loss in Obese Patients
  • Smoking Cessation
  • Breathing Exercises
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Exercise induced asthma indicates what?

A

Exercise induced asthma indicates poorly controlled asthma, may need stepping up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the process for stepping down in Asthma

A

To avoid unnessary costs, treatment is stepped down gradually every three months, Patients should be on the lowest dose of inhaled corticosteroid.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the Guideline for Asthma treatment for children ?

A

Start on SABA

Add Very Low Dose Corticosteroid.

IF under 5 we add LTRA

IF Over 5 we add LABA (but if LABA not effective, stop it)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What should Children Carry with them if they have high doses of Steroids and why?

A

Steroid Card should be issued for high doses, especially in kids as its associated with systemic ADRs such as Growth Failure, Reduced Mineral Bone Density, Adrenal Suppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is Moderate Asthma

A

In Moderate Asthma Patient:

  • Can Talk
  • Respiratory Rate Below 25
  • Pulse below 110b/min
  • O2 Saturation Above 92%
  • Peakflow Greater than 75-50
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

In Severe Asthma What are symptoms

A

Severe Asthma can be any one of:

  • Peak Flow 33-50%
  • Repiratory rate ≥ 25/.minute
  • Heart rate ≥ 110./minute
  • Inability to complete sentences in one breath.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

In Life threatening Asthma what are the features

A

Life threatening asthma can be any of the following:

  • Peak Flow < 33%
  • Arterial O2 Saturations below < 92%
  • PaO2 < 8 kPa
  • Normal Partial Arterial Pressure of CO2 (4.6-6.0 kPa)
  • Silent Chest
  • Cyanosis (Blue discouloration)
  • Poor Respiratory Effort
  • Arrhythmia
  • Exhaustion
  • Altered Consciousness
  • Hypotension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

If a person has Chronic Asthma, What is Step 1?

A

Step 1 is Mild Intermittent Asthma, We give: SABA , such as salbutamol or terbutaline, they’re also the safest SABAs for Asthma. Other SABAs such as ephinephrine hcl is less safe.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Whats step 2 and what determins if a patient switches from step 1 to step 2 in the chronic asthma management plan?

A

Are they using their inhaler more than once a week

Night time symptoms?

Have you had an exacerbation in the last two years?

Give ICS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the inhaled standard dose of a corticosteroid in adults and children over 12 years?

A

200-800 mcg/day on beclometasone disproionate or equivalent (fluticasone and Mometasone have the same clinical activitiy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the inhaled standard dose of corticosteroid for a child between 5-12 years

A

The inhaled standard dose of corticosteroid for a child between 5-12 years is200-400 micrograms per day on beclometasone dispropionate or equivalent. (Fluticasone and Mometasone has the equivalent clinical activity as beclo)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Define Croup and How it’s treated

A

Croup is an inflammation of the larynx and trachea in children, associated with infection and causing breathing difficulties.

Mild Croup is self limiting, but treatment is with a single dose of corticosteroid e.g Dexamthasone is usually offered;

More Severe Croup (or mild croup that might cause complications) calls for hospital admission, nebulised Dexamthasone or budesonide will often reduce symptoms. Adrenaline is a last resort.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

In the event of persistent poor control of Asthma, what doses are the max for:

  1. Children 5-12 years
  2. Adults and Children over 12
A

In persistent poor control, max dose ICS for children below 5 is 800 micrograms/day

for Children over 12 and adults, max dose is 2000 micrograms/day

Note: these are not standard doses.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

In the final step of asthma control, what is given for persistent poor control of asthma?

A

Regular oral corticosteroid (prednisolone as a single daily dose).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Define COPD

A

Chronic Obstructive pulmonary disease, where there is airflow obstruction that is not fully reversible.

Reduced FEV1 / FVC ratio (<0.7).

Progressive and chronic condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What tests do we run for diagnosis of COPD

A
  1. FEV1: The volume of air that the patient is able to exhale in the first second of forced expiration
  2. FCV: The total volume of air that the patient can forcibly exhale in one breath,
  3. The FEV1/FVC ratio determines diagnosis…

We also check:

  • Smoking History
  • Symptoms of breathlessness, persostent cough and sputum.
  • Chest X Ray or chest CT scan.
  • Arterial Blood gas test – oxygen level in blood.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Whats the distinguising features between COPD and Asthma?

A

In Athma

  • Attack triggers - Common and Marked
  • Freedom from symptoms? - Yes outside of the attacks
  • First symtoms - Shortness of Breath and Wheeze.

In COPD

  • Attack triggers - Less Marked
  • Freedom from symptoms? - Unfortunately not
  • First symptoms - Usually chromic cough and expectoration.
21
Q

Give the NICE Algorithm for Treatment if your FEV1 is above 50%? and you have COPD

A

Initially either above 50% or below 50% FEV1 we give SABA or SAMA PRN.

Then, if FEV1 is above 50, and exacerbations or breathlessness is still persistent, give:

  • LABA or LAMA and stop SAMA.

If still persistent, and on LABA give –> LABA + ICS in a combination inhaler.

if still persistent, but on LAMA instead, give LAMA + LABA + ICS.

The final stage for all is LAMA + LABA + ICS

in any case if ICS is declined or not tolerated, stop it and keep LAMA + LABA.

22
Q

Give the algorith for treating a COPD patient if their FEV1 is below 50%?

A

Initially either above 50% or below 50% FEV1 we give SABA or SAMA PRN.

If FEV1 < 50%, we initiate straight to giving LABA+ICS combo inhaler or we can give LAMA on its own, stopping SAMA.

if its still persistent, we go to the final stage:

LAMA + LABA + ICS

in any case if ICS is declined or not tolerated, stop it and keep LAMA + LABA.

23
Q

What are we most concerned about with Selective ß2 agonists?

A

Potentially serious hypokalemia may result from ß2 agonist theapy.. Caution and monitoring is required in severe asthma, as this risk is increased with concominant use with:

  • Theophylline
  • Corticosteroid
  • Diruetics
24
Q

Examples of Long acting ß2 agonists? and what inhalers are they found in?

Can they be given in the onset of an acute asthma attack?

A
  • Formeterol
  • Salmeterol

Formeterol is found in Symbicort, Fostair and Flutiform

Salmeterol is found in Seretide

Salmeterol is not given in the acute relief of an asthma attack, because its much slower than Salbutamol and Terbutaline. Formeterol can be given.

25
Q
A
26
Q

What is the MHRA/ Commission on Human Health advice the use of Formeterol and Salmeterol in asthma?

A

MHRA/ CHM Advice on LAMA in Asthma is:

  • Be added only if regular use of standard-dose inhaled corticosteroids has failed to control asthma adequately
  • Not be initiated in patients with rapidly deteriorating asthma
  • Started @ low dose + Monitored
  • Stopped if not working
  • Stepped up or down if good or bad long term asthma control
  • Combo inhalers used to improve compliance.
27
Q

Examples of Short Acting Muscarinic Antagonist? and any key side effects?

A

Ipratropium is a SAMA that can provide short-term relief in chronic asthma or COPD –> Acute angle-closure glaucoma has been reported with nebulised ipratropium, particularly when given with nebulised salbutamol; avoid getting into eyes!

28
Q

Examples of LAMA? And Which one is Lincensed in Asthma?

A

Aclidinium, Glycopyronium, Tiotropium, and Umeclinidium = LAMA’s licensed for the maintenance treatment of patient with COPD.

Tiotropium (via respimat device) is also lincensed as adjunct to ICS and LABA for maintenance of severe asthma where there are severe exacerbations in the last year.

29
Q

cautions of LAMA?

A

Cautions in LAMA are: Prostatic hyperplasia, bladder outflow obstruction and those susceptible to angle-closure glaucoma. They may also be associated with worsening breathing (Paradoxical Bronchospasm)

30
Q

Theophylline is a high risk drug. What class of drug is it and what is the therapeutic range?

A

Theophylline is an antimuscarinic used as a bronchodilator in asthma, and stable COPD…

10-20mg/L range

Aminophylline is rarely given, but is an infusion for severe acute asthma.

31
Q

Warning signs for theophylline?

A

Warning signs of theophylline

  • Toxicity (Vomiting, agitation, relentlessness, dilated pupils,hyperglycaemia, severe hypokalemia
  • Cardiac Arrhythmias/ Tachycardia

We Monitor for:

Serum Potassium ; Plasma Theophylline Concentration

32
Q

Interactions with theophylline?

A

Interactions with theophylline

  • Salbutamol
  • Increased plasma concentration with diltiazem/ cimetidine and macrolides
  • Reduced plasma concentrations with alcohol/ carbamazepine
33
Q

Can Theophylline be prescribed generically?

A

Nope theophylline can be prescribed as a modified release oral theophylline preparation does not vary between brands.

34
Q
A
35
Q

In asthma or COPD, how do we treat an acute exacerbation?

A

Acute exacerbations are treated with an. oral corticosteroid starting at a high dose. This should only be done after standard operations have been tried

36
Q

Name some Leukotriene Receptor antagonists and state how it works and any cautions

A

Montelukast and Zafirlukast block the effects of leukotriene inflammatory mediators in the airways. Effective with or without ICS.

The cautions are that Zafirlukast may cause persistent nausea, vomiting, malaise, jaundice or dark urine may develop

37
Q

State four key side effects of inhaled corticosteroids

A

ICS side effects

Oral Candida

Adrenal crisis (with prolonged high doses)

aggressive/depressive behavioural changed (particulaly in children)

Hyperglycaemia (in high doses)

38
Q

What is the side effects of withdrawal of opioid therapy?

A

Rare risk reported following the reduction or withdrawal or oral corticosteroid therapy. Symptoms inlude eosinophilia, vasculitic rash, worsening pulmonary symptoms.

39
Q

What are the two brands of beclometasone? Can we interchange and why?

A

Qvar and Clenil Modulite are not interchangeable and should be prescribed by brand name. Qvar has extra-fine particles and is thus twice as potent.

40
Q

Unlicensed use of inhalers?

A

Easyhaler beclometasone is not licensed for children under 18 years

Qvar, Clenil 200 and 250 are not licensed in children under 12 years

41
Q

State some sedating antihistamines

A

Promethazine, Chlorphenamine, Hydroxyzine, Promethazine

42
Q

State some non-sedating antihistamines

A

Acrivastine , cetirizine , desloratadine, levocetrizine , mizolastine

43
Q

Side effects of Antihistamines? and Rare-Side effects?

A

Antimuscarinic activity: CUBD:

Constipation

Uriniary Retention

Blurred Vision

Dry Mouth

Rare Adrs - Heart related so : Hypotention / Palpitation / EPSE / Confusion

44
Q

state the doses of IM adrenaline in the ermergency treatment of prophylaxis

A

Child 1month - 5 years: 150 mcg (0.15ml 1 in 1000) adrenaline

Child 6-11 years: 300 mcg (0.3ml in 1000) adrenaline

Child 12-17 years: 500 mcg (0.5ml 1 in 1000) adrenaline

Adults: 500 mcg.

Doses repeated as necessary every 5 mins

45
Q

Pholcodine Linctus OTC Licencing?

A

Pholcodine linctus is available for children over 6 years, and restricted to less than 5 days treatment or less.

46
Q

What is Codeine contraindicated in?

A

Codeine Contraindications:

  • Children under 12
  • Patients with CYP26D Ultra Rapid Metabolisers
  • Breastfeeding mothers
  • All children under 18 who undergo surgery of tonsils
  • All children under 18 with respiratory problems.
47
Q

Outline the Asthma Management Plan For an Adult

A

LAMA Example - Tiotropium

48
Q
A

BNF: Respiratory System (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions